How to Compare Original Medicare with Medicare Advantage

If you have made the decision to keep Medicare Part B, you now need to decide what Medicare plan type is the best for you. In other words, you need to compare Original Medicare with Medicare Advantage. Depending on where you live, you may choose one of the following types of Medicare plans.

Original Medicare

Medicare Advantage Plan

Other Medicare Health Plans

Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Additional coverage to consider:

Health Maintenance Organization (HMO) Plan

Medicare Cost Plans

– Medicare Part D Plan, AND / OR

Preferred Provider Organization (PPO) Plan

Programs for All-Inclusive Care for the Elderly (PACE)

– Medigap (Medicare Supplement)

Private Fee-for-Service (PFFS) Plan

Special Needs Plan (SNP)

Medical Savings Account (MSA) Plan

This is a very important Medicare choice – like the decision whether to keep Part B; a wrong choice may be difficult to reverse. To help you decide between the Original Medicare and Medicare Advantage, consider the following advantages and disadvantages under each plan.

It may be complemented with a Medicare Supplement Plan (Medigap Plan) to protect against catastrophic out-of-pocket expenses incurred while on Parts A and B of Original Medicare. Buying a Medigap policy limits your out-of-pocket expenses.

Benefits of Medicare Advantage

Medicare Advantage Plans must cover all of the services that Original Medicare covers. The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare.

Medicare Advantage premium is typically lower in comparison with Medicare Supplement and Prescription Drug plan. The $0 premium plans may be available in your area.

Beneficiaries with preexisting conditions will not be denied enrollment or charged increased premiums. There are no health questions asked, and acceptance into Medicare Advantage is guaranteed (except the beneficiaries with ESRD).

Plans may include extra services not covered by Original Medicare, such as dental and vision.

Disadvantages of Medicare Advantage

You are always responsible for copayments and coinsurances, and sometimes even for deductibles. Therefore, the cost could be quite high. There is out-of-pocket limit – $6,700/year.

Your choice of doctors/hospitals is limited by the provider network within a specific geographic area. Members are required to pay an increased cost, sometimes up to the full cost, for services outside the provider network.

Medicare providers may not always accept Medicare Advantage plans, so your choices may be limited. Some doctors and hospitals do not participate in any Medicare Advantage plans and others only in a selected few..

Many plans require referrals for specialists and other services.

Medicare Advantage plans may change every year. Such changes may affect your premium, deductibles, copayments/coinsurances, and the scope of extra services.

How to Compare Original Medicare with Medicare Advantage: Weighing Your Options

Although Medicare Advantage plans are supposed to cover everything that Original Medicare covers, there is no obligation to cover every benefit in the same way.

The main appeal of a Medicare Advantage plan is that it is less expensive than a combination of Original Medicare and a Medicare Supplement plan. It also includes some extra benefits that are not part of Original Medicare.

The disadvantages of a Medicare Advantage plan are that you are limited by the provider’s network; many plans pay less for some benefits (like skilled nursing care facilities); and out-of-pocket yearly expenses can go up to $6,700. In addition, the services are inexpensive ONLY if they are within the plan’s network.

Recommend Tips for Choosing Medicare

Consider enrolling in a Medicare Advantage Plan as long as you are healthy and willing to stay within the plan’s network. Remember that as you increase your use of the services (which typically happens the older we become), your out-of-pocket expenses will start to exceed any premium savings.

Otherwise, select the Original Medicare and complement it with a Medigap policy. In the case of serious illness, without Medigap stop-loss protection, you may incur very high medical bills.

If you are looking for Medicare advice in deciding whether to select Original Medicare or Medicare Advantage, let us help you. To see quotes from Medicare providers fill out our Medicare Quote form. Alternatively, give us a call at 877-657-7477, and you will be connected to a licensed agent/broker.

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